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THE IDENTIFICATION AND TREATMENT OF DISCITIS AND SPINAL
INFECTIONS
Sattorov Bekhruz Kobilovich
Assistant of Bukhara state medical institute named after Abu ali Ibn Sino
Email: sattorovbehruz804@gmail.com
https://doi.org/10.5281/zenodo.13923625
Abstract
Discitis and spinal infections are frequently encountered in spinal surgery, but their
diagnosis and management can be complex. Early identification and treatment typically result
in favorable patient outcomes, often avoiding the need for surgery. However, delayed cases
with neurological impairment constitute a surgical emergency, necessitating urgent
intervention to prevent permanent spinal cord damage and deformities. A multidisciplinary
approach, including collaboration between surgeons and microbiologists, can help avert the
need for surgery. This review article discusses the essential elements of diagnosing and
managing discitis and spinal infections, drawing on the latest literature and evidence.
Introduction
Spinal infections encompass a spectrum of clinical conditions, as various anatomical
structures can be affected, including the vertebral bodies, intervertebral discs, spinal canal, and
paravertebral tissues. The term spondylodiscitis broadly refers to vertebral osteomyelitis,
spondylitis, and discitis, which are considered different manifestations of the same pathological
process. Spinal infections can also be classified by cause: pyogenic (bacterial), granulomatous
(tuberculous or fungal), and parasitic (Echinococcosis).
These infections are not a modern phenomenon, with the earliest recorded case dating
back to the Iron Age. In 1911, Hibbs pioneered spinal surgery as a treatment for spinal
tuberculosis, performing the first spinal fusion. In recent years, a rise in immunocompromised
patients, an increase in spinal procedures, and advancements in radiological imaging have
contributed to the growing number of diagnosed spinal infections.
Spondylodiscitis is a complex condition that demands a multidisciplinary approach to
ensure proper medical and surgical management. Early diagnosis, followed by intensive
medical therapy and surgical intervention when necessary, is crucial for achieving favorable
outcomes. This review examines the epidemiology, pathophysiology, clinical features,
diagnostic investigations, and treatment of spondylodiscitis based on the latest evidence.
Epidemiology and Risk Factors
The epidemiological pattern of discitis shows a bimodal distribution, with two peak
incidences: one in children during the first and second decades of life, and the other in adults in
their fifth and sixth decades. In adults, males are affected twice as often as females. The lumbar
spine is the most commonly involved region (58%), followed by the thoracic spine (30%) and
cervical spine (11%), which can be attributed to variations in blood flow to different sections
of the vertebral column.
Several risk factors are associated with the development of discitis, including underlying
conditions that may compromise immune function and an increase in spinal procedures.
Pathophysiology
Spinal infections primarily occur via two routes: haematogenous and non-haematogenous. The
haematogenous spread is more common, where circulating organisms from pre-existing
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bacteraemia reach the spine through the rich arterial blood supply to the vertebral bodies and
the paravertebral plexus (Batson’s plexus). The most frequent sources of these infectious
agents are the oral cavity, urinary tract, and gastrointestinal system.
Causative Organisms
Most spinal infections are caused by a single organism, though approximately 20% of
cases involve polymicrobial infections. Staphylococcus aureus is the leading causative
organism, responsible for up to 50% of spinal infections. The increasing prevalence of
methicillin-resistant Staphylococcus aureus (MRSA) poses a significant challenge in treatment.
Other pathogens implicated in spinal infections include Gram-negative bacilli, such as
Escherichia coli.
Clinical Features
The clinical presentation of spinal infections can vary depending on factors such as age,
immune status, the causative organism, and the location and extent of the infection. The earliest
and most common symptom is back pain, which typically worsens at night. The most reliable
clinical sign indicative of spinal infection is localized tenderness during gentle spinal
percussion. This may be accompanied by reduced mobility and muscle spasms.
Blood Tests
Blood markers are among the first indicators of an infectious process in the spine and
should be part of the diagnostic workup. The most sensitive laboratory tests for diagnosing
discitis are C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), which are
elevated in more than 90% of cases. However, since CRP and ESR are non-specific, their results
should be interpreted in the clinical context. White cell count (WCC) is less useful, as it is
elevated in only about 50% of patients.
Imaging
Initially, plain radiographs may be obtained, but these are often normal in the early stages
of the disease, and radiological changes may not appear for two to three weeks. Typical imaging
findings in spondylodiscitis include destruction of two adjacent vertebral bodies with collapse
of the intervening disc space. In rare cases, infection may affect only one vertebral div,
mimicking a compression fracture on radiographs. MRI remains the gold standard for
diagnosis.
Biopsy
The use of biopsies for spinal infections has decreased due to advancements in diagnostic
MRI. However, in cases where blood cultures are negative and imaging is inconclusive, a direct
biopsy of the affected vertebral div is recommended. This is typically done via CT-guided
biopsy, often performed by an interventional radiologist, with a success rate of up to 75% when
executed properly. Multiple sites should be sampled during biopsy, including both the vertebral
div and adjacent areas.
Management
The primary treatment for spinal infections is appropriate antibiotic therapy. The main
objectives are to eliminate the infection, preserve or improve neurological function, and
maintain or restore the stability of the spinal column.
Monitoring and Prognosis
After treatment, close follow-up is essential to monitor for either improvement or
deterioration. Patients should be followed throughout the course of treatment and for up to one
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year after its completion to detect potential relapses. Follow-up includes regular monitoring of
inflammatory markers, periodic radiographs, and therapeutic drug monitoring when
applicable. Clinical improvement is the key measure of progress, and follow-up CT or MRI is
usually not required unless there are concerns about recurrence.
Summary
In summary, spinal infections and discitis are important spinal pathologies that must be
promptly recognized and managed. These conditions are often underdiagnosed, and a high
index of suspicion is necessary, especially as incidence is increasing. Haematogenous spread is
the most common route of infection, with Staphylococcus aureus being the most frequently
isolated organism. The most reliable clinical sign is back tenderness on light palpation or
percussion, and the cornerstone of treatment is prolonged antibiotic therapy.
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